Live Blood Analysis and nutritional microscopy - unconvincing so far

Update 20 April 2018: Today the subject of this post was fined £2,200, ordered to pay costs of £15,000 and given a Criminal Behaviour Order (which, if breached, puts him in contempt of court). The Advertising Standards Authority referred his protracted case(s) to Camden Trading Standards who brought proceedings, resulting in a trial at Blackfriars Crown Court which concluded in March 2018 with sentencing today. The ASA has said that it welcomes the outcome. See also info from Court News.


Update 12 October 2014: On Friday the subject of this post was fined £4,500 and lost his appeal at Southwark Crown Court. I don't know if the £4.5k is an adjusted figure or an addition to the previous fines. 

Update 20 March 2014: Today the subject of this post was fined £9,000 for nine counts of the Cancer Act of 1939 at Westminster Magistrates Court and handed a total bill (including costs) of over £19,000. He did not attend this final court hearing and did not represent himself.

EDIT: 13 October 2010 - the Advertising Standards Authority have now adjudicated on the leaflet and the complaint was upheld - details of two other upheld adjudications are below.

The shortened link for this page is http://is.gd/bdoh0

Earlier today I picked up a flyer for a 'nutritional microscopy' service which claims that a drop of blood, viewed under a microscope, can be used to identify the following

* relative level of acidity in the body fluids and the effects they have especially for weight loss!
* blood sugar imbalance
* vitamin deficiency, allergies, cholesterol
* uric acid and mycotoxins
* gastro-intestinal tract dysfunction
* detection of parasites, yeast, fungus and mould
* imbalance associated with degenerative conditions ect (sic)

Flyer page 1 | Flyer page 2

Not surprisingly Quackwatch doesn't have much time for the claims made by this sort of thing:
Live Blood Cell Analysis: Another Gimmick to Sell You Something
http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/livecell.html

This looks like something for the Advertising Standards Authority to investigate as the claims seem... a little unlikely. Before I write a letter of complaint to the ASA I wanted to find out a bit more about some of the claims and also to find out what light microscopy can and can't do in terms of diagnosing things to do with blood. I shall add to this post as I come across things of interest, while trying to trim the text a bit.

Detection of parasites...
Tempting as it is to denounce the entire flyer as unmitigated nonsense it probably pays to be a bit careful as light microscopy of blood can apparently be used in the diagnosis of some infections (malaria, with a bit of staining of the smear) or conditions (sickle cell anaemia). PLos One has a paper on turning a mobile phone into a microscope for global health applications which includes some example pictures:

Mobile Phone Based Clinical Microscopy for Global Health Applications
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0006320

The paper suggests that diagnosing malaria from blood microscopy is fairly uncontroversial, but this does not seem to be the case for Lyme disease - from borrelia spirochaetes. I hadn't realised that Lyme disease has its own subset of woo tests, one of which is inappropriate use of microscopy.

Unorthodox and unvalidated laboratory tests in the diagnosis of Lyme borreliosis and in relation to medically unexplained symptoms
http://www.dh.gov.uk/assetRoot/04/13/89/17/04138917.pdf

Microscopy of whole blood (p5 of 9)
"It has been claimed that chronic Lyme borreliosis can be diagnosed on the basis of
seeing spirochaetes in the blood of patients by high power (on-screen magnification
reported to be X 10,000) ‘live’ microscopy of blood. A drop of blood is placed on a
microscopy slide, covered with a cover slip, and then left to stand for a period of at
least 6 hours and up to 24 hours in a moist chamber. The film is then examined by
dark field and phase contrast microscopy. It is claimed that spirochaete forms can be
seen emerging from red and white cells in these blood films. They have been
described as being ‘intracellular L-forms’ that can be seen emerging from blood cells.
Patients and medical practitioners have been told that this test for Lyme borreliosis is
positive in chronic fatigue syndrome patients, showing that CFS is caused by chronic
B. burgdorferi infection."

"However, these tests are not being performed by medical practitioners or
clinical/biomedical trained or qualified in laboratory medicine specialties such as
microbiology, parasitology or haematology that would include specific training in
light microscopy. They are not performed in laboratories accredited for clinical
pathology testing."

The article continues with

1. Microscopy of whole blood (p7 of 9)
"The objects purported to be borreliae in the whole blood films are not considered to
be borreliae but to represent artefacts of the method used. If they were spirochaetes
the number demonstrated by light microscopy in such a small sample would indicate a
substantial spirochaetaemia which could readily be confirmed or refuted by electron
microscopy, immunofluorescence or PCR. Some of the structures appear to be
contaminating debris, as would be expected in samples collected by inexperienced
individuals (patients, carers etc) in non-sterile conditions. Other strands appear to be
fibrin produced by the clotting mechanism that would occur in whole blood held for
several hours in this way, collagen fibrils or cell membrane fragments shed from
degenerating red and white blood cells."

.....

"Furthermore, the biological basis for the test is fundamentally wrong. B. burgdorferi
sensu lato is an extracellular bacterium in the bloodstream. It is not an intracellular
bacterium that could be seen ‘emerging from infected blood cells’. Moreover, any
spirochaetes in a thick blood smear, covered by a cover slip, would not remain viable
for long. Blood is not an ‘ideal medium’ for borreliae, the organisms are fragile in
vitro, requiring special media and careful temperature regulation. Spirochaetemia
occurs in the early stages of infection and is intermittent and short lived, with a low
number of organisms."

.....

"Diagnostic tests that require microscopy or culture of samples from patients should be
supervised and the results interpreted by consultant medical microbiologists or
clinical scientists of equivalent standing. Tests should also be done in an accredited
laboratory with quality assurance standards."

The HPA (Health Protection Agency, UK) specifically mentions that microscopy isn't recommended in the diagnosis of Lyme disease.

Diagnosis and Treatment of Lyme borreliosis Clinical signs of Lyme borreliosis (LB)
http://www.hpa.nhs.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1204031510081

Unorthodox Clinical and Laboratory Practices Related to Lyme borreliosis (overview)
http://www.hpa.nhs.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1204013002855

I'm not convinced that it's possible to tell anything about 'blood sugar imbalances' from looking at blood cells. There are easier enzymatic methods used to test blood glucose concentrations from a small drop of blood, and laboratory (eg chromatographic) methods for assessing how much haemoglobin in the blood has had glucose added to it ('glycated' - the test for this is called the HbA1c test). I have to assume that some sort of chemical testing is being implied by this claim.

Discussion on Twitter with @medtek suggested that other information can be gleaned from blood smears, including a limited assessment of vitamin deficiency in the case of B vitamins leading to different types of anaemia - but even this would be confirmed by a test for serum levels of the vitamin/metabolites.

Flyers are generally a little more circumspect regarding health claims but the website to which this flyer leads has information implying that iridology can help too (nonsense) and there's even an opportunity to have an online iridology consultation
http://www.livebloodtest.com/membershealthclub.php?gid=1

This mp3 is quite illuminating (a phone in to an LBC radio show)
http://www.livebloodtest.com/images/march2010.mp3

More to follow... at some point...

EDIT: 13 October 2010 - the complaint was upheld

----------- EDIT 5 April 2010 ------------

Lab Tests Online is a very useful resource for finding out about different blood tests - this is a page on the UK version (there's are little flag icons on every page providing information for other countries too) about taking a pinprick of blood, smearing it on a slide and peering at it microscopically: Blood Film: At a Glance
http://www.labtestsonline.org.uk/understanding/analytes/blood_film/glance.html - this is the overview page, note the other tabs on the page for more detailed information on what this type of test can be used for.

Further reading
Fellow blogger Josephine Jones has also been writing on Live Blood Analysis, for example see these two posts:

• Introducing the curious world of the Alkaline Diet and Live Blood Analysis (22 March 2011)
• My third ASA adjudication: Groupon’s Live Blood Test claims exaggerated, misleading and unsubstantiated (7 September 2011)

A new era of scientific discovery? (12 July 2005) by Edzard Ernst, in The Guardian.

"Intrigued by the spectacular claims made for Live Blood Analysis? Don't be. It doesn't work"The three Advertising Standards Authorities adjudications which were upheld are as follows:

• Live Blood Test (13 October 2010) - a leaflet advertising Live Blood Test in Harley Street
• Fitalifestyle Ltd trading as seemycells.co.uk (1 June 2011) - an onlnie advert for liquid chlorophyll sold on seemycells.co.uk (same owner registration details as livebloodtest.com)
• MyCityDeal Ltd trading as GrouponUK (7 September 2011) - a promotion for Live Blood Test which provoked some angry comments on other blogs (including Josephine's) and forums

Also known as live blood test, see my cells, nutritional microscopy

BBC Radiophonic Workshop - Alchemists of Sound 2003

The shortened URL for this post is http://is.gd/b5rA2

Alchemists of Sound (2003): BBC Radiophonic Workshop Length: 1hr
Filetype: wmv (175Mb) or avi (700Mb) - right-click / save as definitely works, no idea if it'll stream (try!). I watch it using the free VLC (VideoLAN) player which is fab.

The whole programme is also available, in smaller chunks, at YouTube (part one) and it abounds on the internet. Further information on the programme from BBC's website

---

This is a documentary I watched at 8pm one evening in 2005 and was so enchanted I stayed up to watch the repeat at 3am. Then I was straight on to the internet the next day at work to hunt it down or see if I could buy a copy from the BBC / 2Entertain (nope, no plans to release it that I'm aware of).

If you've not seen this and you delight in strange and quirky sounds, and in the ingenious ways in which these sounds were turned into an acoustic backdrop (or actual music) using tape loops to record raw sound and manipulate it, then this is a suitable programme for you. It's the slightly spooky soundtrack to some of my childhood.

Narrated by Oliver Postgate it also features interviews with the workshop geniuses and some others, including Robert Popper and Peter Serafinowicz who gave us "Look Around You".

In 1991 there was an exhibit called "Behind the Sofa" at the now defunct Museum of the Moving Image by Waterloo, London - I remember all sorts of Dr Who memorabilia being on show but the bit that made me smile in particular was the panel of buttons which let you hear the various versions of the theme tune. Magic :)

Here's a video of the Dr Who theme tune, recorded live at the Radiophonic Workshop's gig at the Camden Roundhouse last year (I didn't record it but I was there enjoying it).

Some thoughts on herbal remedies and diabetes

A shortened link for this post is http://is.gd/aJEfH

Medicines from plants
There are many preparations containing plant ingredients which have been claimed to help people with diabetes manage their condition. As well as the sugars, proteins and fats (oils) that plants use for fuel, storage and building blocks, plants produce many other chemicals that protect them from being eaten (for example by herbivorous animals) and help in repairing damage. Many of these chemicals have effects (whether these are beneficial or negative is often be a consequence of dose, as much as of the nature of the molecule(s) involved) in humans and have for years been exploited in medicine.

Aspirin tablets contain a chemical which has its origin in a similar chemical found in the bark of the willow tree (Salix alba) and in the woody shrub known in North America as meadowsweet (from the Spiraea family). Similarly metformin, used in the treatment of Type 2 diabetes, is a safer synthetic form of a chemical compound originally found in French lilac (Galega officinalis). A significant number of modern day pharmaceutical preparations have their origins in chemicals extracted from plants and so it is not unreasonable for people to think that plant material may be helpful in treating diabetes and other conditions.

Herbal preparations are sometimes wrongly advertised as being safer alternatives to prescription medications because they contain only natural ingredients. However it is important to remember that 'natural' does not necessarily mean 'harmless', an example being the poison ricin which is extracted from the castor bean plant (Ricinus communis).

Claims are also often made for herbs and spices which are typically used at relatively low doses in flavouring foods. At higher doses these same herbs or spices may begin to have pharmacological effects on the body and it may not be safe to take them for a long time at such high doses. In addition to the active ingredient some plants contain other chemicals that can also be harmful at higher doses.

It is important to remember that herbal preparations, and other alternative treatments, can contain:

• an active ingredient which may be harmful
• an active ingredient which may not be harmful by itself but which may interact with other prescribed medication(s) which can cause that medicine to work differently and can also worsen the risk of a serious hypo (low blood glucose)
• adulterants – that is other chemicals added to the preparation, for example prescription-only medicines, medicines that have been withdrawn (Wood, 2004) or heavy metals sometimes found in Ayurvedic treatments
• ingredients which have no or insufficient effect on blood glucose control, or which contain no ingredients at all.

I’ve previously tried to find out how harm can be categorised as I’ve assumed someone must have arrived at this problem before me… any ideas?

I'm not aware of any good evidence recommending that any herbal preparation can be effectively or safely used to treat diabetes but of course this wouldn't prevent someone from trying a treatment if they wanted to. My advice, such as it is - I am not medically trained and there's the potential to do oneself quite a lot of harm with alternative treatments, is to take a pragmatic approach to herbal products.

I'd suggest that people with diabetes discuss them with their doctor or healthcare team, consult their pharmacist for advice about any known interactions and, if appropriate, monitor their blood glucose levels more closely to prevent hypos (low blood glucose levels) or to make sure that glucose levels do not rise. If someone with diabetes needs any changes to prescription medication, this should really only be done on the advice of a medically qualified doctor.

Avoid buying products from the internet – moneyback guarantees mean very little – and ignore hype, and patient testimonials (which are unlikely to be real).

References (see also in-text links)
Wood, DM, Athwal, S and Panahloo, A (2002) The advantages and disadvantages of a 'herbal' medicine in a patient
with diabetes mellitus: a case report. Diabetic Medicine, 21 (6): 625-627.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/15154951

A 48 year old man improved his diabetes management in the short term, and stopped taking other medication, after using herbal 'balls' purchased in India. It was subsequently discovered that the herbal preparations contained chlorpropamide, a prescription-only medicine that is no longer recommended in treating diabetes.

Recommended reading
Shane-McWhorter, L (2007) Complementary & alternative medicine (CAM) supplement use in people with diabetes: a clinician's guide. American Diabetes Association, Alexandria, Virginia.

See also
Campbell, AP (2010) Diabetes and dietary supplements Clinical Diabetes website.
Article available from http://clinical.diabetesjournals.org/content/28/1/35.full

Post for @garwboy

This post is non-canonical and is logically equivalent to Twitlonger except I decided to put it here :)

Some suggestions
ABSW has a Christmas party and might like to hear your amusing and entertaining stories, mind you if it's vastly critical of the media probably it won't go down awfully well given that it's the Association of British Science Writers (of which I'm a member).

The British Science Association (nee The BA) has an annual Science Communication Conference coming up in May - I don't know how much of the programme is in place but they do often end with a bit of entertainment after the final plenary. You could be that entertainment...

The Science Media Centre, based at the RI, hosts half-day sessions for scientists to hear more about working with the media. The purpose of these is to encourage scientists to get involved, and early on in their careers, and communicate their work via the media. If your stories include things about what not do to, that might work. I believe Wellcome may also host something similar, and possibly the Royal Society - but I might be wrong.

Cancer Research UK do their own in-house training for their own scientists in talking about the research that the scientists do and which Cancer Research UK fund - they may not need any further input but you can but ask.

You could ignore the media-mediator concept entirely and just go to the science departments in universities or to the professional societies and give them a presentation discouraging them from talking to the media - however I wouldn't seriously suggest this as being a good idea, and would actively discourage you from doing this myself, somewhat ironically.

I don't know of any publications that would be particularly interested in this, with the emphasis being 'I don't know' rather than implications that they wouldn't be interested. I'm guessing they wouldn't rush to publish stuff that might be a bit 'insulting' to them but depends how you're pitching your material.

That's all I can think of at this precise moment...

Thiamine or benfotiamine use in people with diabetes

This is another draft document (see yesterday's on glucosamine and chondroitin) - written by me and no-one else - based on my reading of the literature. It might be wrong and I would strongly advise anyone reading to consider this 'preliminary' and to take any medical advice not from me (not medically trained) but from their own doctor / healthcare team.

Having said that, I'd be grateful if you told me if this did or didn't make sense - or if you think I've missed an important paper or given undue weight to a less important one.

A short URL for this page is http://is.gd/a3kR8

Thiamine or benfotiamine use in people with diabetes
The Vitamin B complex is a group of water-soluble vitamins including thiamine (vitamin B1), riboflavin (vitamin B2), nicotinic acid (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), biotin (vitamin B7), folic acid (vitamin B9) and cyanocobalamin (vitamin B12) with other compounds (Ang 2008). All of the B vitamins are required in the diet in very small amounts as these essential substances cannot be synthesised by the body.

Specific vitamin B deficiency diseases in humans include beriberi (thiamine, vitamin B1), megaloblastic anaemia (folic acid, vitamin B9), and pernicious anaemia (cobalamin, vitamin B12); these B vitamins may be of particular importance in people with diabetes.

I'm planning a follow up on folic acid and cobalamins - women with diabetes who are or wish to be pregnant are currently advised to take 5mg (available only on prescription) of folic acid to prevent neural tube defects, and in long-term use of metformin there can be a reduction in the absorption of cobalamin / B12.

Folic acid supplementation in pregnancy
http://www.diabetes.org.uk/about_us/our_views/care_recommendations/folic_acid_supplementation_in_pregnancy/

Metformin SPC (go to section 4.8 - undesirable effects)
http://emc.medicines.org.uk/medicine/1043/SPC/Glucophage+500+mg+and+850+mg+film+coated+tablets/

Thiamine (Vitamin B1)
Recommended levels of thiamine are 1mg a day for men and 0.8mg for women (Food Standards Agency) and up to 1.8mg/day in pregnant or breastfeeding women (Expert group on vitamins and minerals, 2003). Thiamine present in food is efficiently absorbed; however water-soluble supplements may be less well absorbed (Expert group on vitamins and minerals, 2003).

Good sources of Vitamin B1 include "unrefined grain products, meat products, vegetables, dairy products, legumes, fruits and eggs" (Expert group on vitamins and minerals, 2003). Fortification of white and brown flour with thiamine (not less than 0.24mg/100g flour) to replace that lost during processing means that cereal products are also a rich source of this vitamin (Expert group on vitamins and minerals, 2003).

Benfotiamine is a fat-soluble derivative of Vitamin B1 / thiamine and may have greater bioavailability (Stracke 1996).

Thiamine (Vitamin B1) deficiency in people with diabetes
In the general population a severe lack of thiamine, resulting from malnutrition, leads to the deficiency syndrome known as beriberi which is characterised by serious painful neurological and muscular problems, including cardiovascular problems. Heavy alcohol use can also impair the uptake and use of thiamine leading to its deficiency and can result in painful alcoholic neuropathy.

A small pilot study has indicated that people with Type 1 or Type 2 diabetes may be generally deficient in thiamine, perhaps as a consequence of increased renal clearance of the vitamin rather than a lack in the diet or problems with absorption. This may increase the risk of microvascular complications, in particular diabetic kidney disease (Thornalley 2007).

Thiamine or benfotiamine in the treatment of diabetic neuropathy (nerves)
Although thiamine supplementation has been used to treat generalised peripheral neuropathy its effectiveness in this, or in diabetic neuropathy is not clear. A Cochrane review concluded that “there are only limited data in randomised trials testing the efficacy of vitamin B for treating peripheral neuropathy and the evidence is insufficient to determine whether vitamin B is beneficial or harmful” (Ang 2008).

One trial suggested that short-term (eight weeks) use of benfotiamine could improve vibration-perception threshold in people with general peripheral neuropathy (Ang 2008).

The BENDIP (benfotiamine in diabetic polyneuropathy) study, a double-blinded, randomised, placebo-controlled trial funded by a company which produces benfotiamine, compared the effect of two doses (300 and 600mg daily) of benfotiamine on people with diabetic neuropathy (Stracke 2008). This study built on a previous pilot trial (41 patients in a trial of three weeks' duration) which suggested that benfotiamine produced improvements in the symptoms of neuropathic pain (Haupt 2005) without any change in blood glucose levels. The BENDIP trial indicated that the higher dose of benfotiamine was helpful in reducing pain symptoms, though other neuropathic symptoms (eg numbness, burning or the sensation of pins and needles) were not improved.

A Cochrane review of trials using Vitamin B1 or benfotiamine in the treatment of general peripheral neuropathy found that benfotiamine was effective in improving, in the short term, the ability to detect vibrations (Ang 2008).

Thiamine or benfotiamine in the treatment of diabetic nephropathy (kidneys)
A pilot study of 40 subjects with Type 2 diabetes compared the effect on urinary albumin excretion of a high dose of thiamine (3 x 100mg capsules per day) with a placebo pill (Rabbani 2009). Over a period of three months the 20 patients taking thiamine had a decrease in their urinary albumin excretion compared to those taking the placebo and it was reported that the effect of thiamine might persist beyond treatment (the urinary albumin excretion continued to decrease after the treatment had finished) however factors other than thiamine may have contributed to this (Alkhalaf 2009).

This suggests that thiamine supplementation in people with Type 2 diabetes may result in regression of albuminuria (urinary albumin excretion). However the issue of baseline differences between the treatment and placebo groups may mean that the subsequent differences were less significant, particularly given the small size of the two groups (Alkhalaf 2009).

Current or future clinical trials
At the time of writing (May 2010) there are a number of registered trials which are or will examine the effects of thiamine or benfotiamine supplementation in people with diabetes, in particular any effects on the prevention or improvement of microvascular complications including diabetic nephropathy and neuropathy (ClinicalTrials.gov).

References
Alkhalaf A. (2009) Thiamine in diabetic nephropathy: a novel treatment modality? Diabetologia 52(6): 1212-1213.
Available from http://pubget.com/paper/19296076?title=Thiamine+in+diabetic+nephropathy%3A+a+novel+treatment+modality%3F

Ang, CD, Alvia, MJM, Dans AL et al (2008) Vitamin B for treating peripheral neuropathy (review). Cochrane Collaboration, 4.
Available from http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD004573/pdf_fs.html

ClinicalTrials.gov – search resultshttp://www.clinicaltrials.gov/ct2/results?term=benfotiamine
http://www.clinicaltrials.gov/ct2/results?term=thiamine+and+diabetes
http://www.clinicaltrials.gov/ct2/results?term=vitamin+b1+and+diabetes

Expert Group on Vitamins and Minerals (2003) Risk assessment: Thiamin (Vitamin B1) Food Standards Agency
Available from http://www.food.gov.uk/multimedia/pdfs/evm_thiamin.pdf

Food Standards Agency: Thiamin Food Standards Agency website
Available from http://www.eatwell.gov.uk/healthydiet/nutritionessentials/vitaminsandminerals/thiamin/?lang=en

Haupt E et al (2005) Benfotiamine in the treatment of diabetic polyneuropathy - a three week randomized, controlled pilot study (BEDIP study). International Journal of Clinical Pharmacological Therapeutics, 43 (2): 71-77.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/15726875

Rabbani, N, Alam, SS, Riaz, S et al ((2009) High-dose thiamine therapy for patients with Type 2 diabetes and microalbuminuria: a randomised, double-blind placebo-controlled pilot study. Diabetologia, 52: 208–212.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/19057893

Stracke H, Lindemann A, Federlin K (1996) A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy Exp Clin Endocrinol Diabetes 104 (4): 311-316.
Abstract available from http://www.ncbi.nlm.nih.gov/pubmed/8886748

Stracke H, Gaus W, Achenbach U et al (2008) Benfotiamine in diabetic polyneuropathy (BENDIP): results of a randomised, double blind, placebo-controlled clinical study. Experimental and Clinical Endocrinology and Diabetes, 116 (10): 600-605.
Available from http://www.biovita.fi/uusi/pdf/Stracke_2008.pdf

Thornalley PJ, Babaei-Jadidi R, Al Ali H et al. (2007) High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Diabetologia, 50 (10): 2164-2170.
Available from http://ukpmc.ac.uk/articlerender.cgi?artid=1091977

Further reading
Brownlee, M (2004) The pathobiology of diabetic complications: a unifying mechanism. Diabetes, 54 (6): 1616-1625.
Available from http://diabetes.diabetesjournals.org/content/54/6/1615.full.pdf

Manzella D (2007) Is benfotiamine effective for treating diabetic complications? About.com: Type 2 diabetes website.
Available from http://diabetes.about.com/od/whatsonthehorizon/p/benfotiamine.htm

Medline Plus
Thiamin (thiamine), vitamin B1
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-thiamin.html

TRIP (2007) Is there evidence supporting the use of thiamine or benfotiamine to reduce complications in diabetics? If there is what dose would be recommended? tripanswers website
http://www.tripanswers.org/answer.aspx?criteria=&tagtrail=%2fdiabetes%2fbenfotiamine%2f&qid=4059&src=0